title: Training surgeon status is not associated with an increased risk of early or late mortality after isolated aortic valve replacement surgery.
abstract: BACKGROUND
  Few studies have addressed the effect of "trainee surgeon" status on outcomes after isolated aortic valve replacement (AVR).
  
  
  RESULTS
  A retrospective analysis of data, collected by the Australasian Society of Cardiac and Thoracic Surgeons Cardiac Surgery Database Program between June 2001 and December 2009 was performed. Patient demographics, intra-operative characteristics and early morbidity were compared between trainee and staff cases. Multivariate analyses were used to determine the independent association of training status with 30-day and late mortality. Isolated AVR was performed in 2747 patients; of these, 369 (13.4%) were by trainees. Compared to staff cases, trainee cases were less likely to present with renal failure (1.1% vs. 3.7%, p = 0.010) or in a critical preoperative state (1.4% vs. 3.7%, p = 0.020). The mean EuroSCORE was lower in trainee patients, compared to staff patients (8.11 ± 2.80 vs. 8.81 ± 3.09, p < 0.001). Trainee cases had longer mean perfusion (117.9 min vs. 98.9 min, p < 0.001) and cross-clamp (88.8 min vs. 73.2 min, p < 0.001) times. The incidence of early complications was similar between the two groups, except for post-operative myocardial infarction (1.1% vs. 0.3%, p = 0.008) and red blood cell transfusion (43.9 vs. 40.0%, p = 0.006). On multivariate analysis, trainee status was not associated with an increased risk of 30-day mortality (2.2% vs. 2.4%, p = 0.823). Moreover, there was no significant difference in long-term outcomes and 5-year survival was comparable in both groups (89.9% vs. 84.8%, p = 0.274).
  
  
  CONCLUSIONS
  Isolated AVR can be safely and effectively performed by trainee surgeons who are strictly supervised in the operating theatre especially during the technically complex parts of the procedure.
authors.forename: Akshat
authors.initials: A
authors.lastname: Saxena
authors.forename: Diem
authors.initials: D
authors.lastname: Dinh
authors.forename: Julian A
authors.initials: JA
authors.lastname: Smith
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Reid
authors.forename: Gilbert
authors.initials: G
authors.lastname: Shardey
authors.affiliation: Department of Cardiothoracic Surgery, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia, Department of Surgery, University of Melbourne, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia. andrew.newcomb@svhm.org.au.
authors.forename: Andrew E
authors.initials: AE
authors.lastname: Newcomb
mesh_terms: D000368:Aged; D001021:Aortic Valve / Q000601:surgery*; D016009:Chi-Square Distribution; D002983:Clinical Competence; D016208:Databases, Factual; D004503:Education, Medical, Graduate; D005260:Female; D006349:Heart Valve Diseases / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000193:education* / Q000401:mortality*; D017052:Hospital Mortality; D006801:Humans; D007396:Internship and Residency; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D061646:Operative Time; D011183:Postoperative Complications / Q000401:mortality* / Q000628:therapy; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D066231:Surgeons / Q000193:education*; D013997:Time Factors; D016896:Treatment Outcome; D014739:Victoria